Primary care has been an under-utilized resource for childhood obesity prevention. Promotion of healthy lifestyles in younger children when families still play a major role in controlling their environment and modeling behaviors is key. However, obesity prevention counseling during well child care is challenging due to difficulties in efficiently gathering data on child/family behaviors, lack of point of care clinician supports for effective counseling, and the need for family reinforcement of planned changes. We propose a feasibility study of an innovative family-focused intervention for primary care to meet these needs in rural, low-income...communities. Family readiness to change will guide the counseling and post-visit planned post visit reinforcement. This project brings together personal data assistant (PDA) technology, a community Practice Based Research Network (PBRN), and a research team experienced in office system change, to design and pilot test a primary care office system to address obesity risk, we will extend that work to obesity prevention in children through four specific aims. 1) Using hand held PDAs, we will develop an obesity risk screening and counseling system well child visits (WCV) for ages 4 -10. PDA summarized screening results will prompt the clinician to provide brief counseling messages tailored to each child's obesity risk behaviors and family readiness to change behavior. 2) We will evaluate the specific content and quality of clinician obesity counseling provided at the WCV through parent surveys before and after implementation of the PDA screening and counseling program. 3) To support action by families post visit, we will develop a post-visit intervention package of newsletters and materials also tailored to child/family obesity risk behaviors and parental readiness to change. 4) We will evaluate the impact of this post visit intervention program in a 6 month trial focused on children identified with BMI >85%. Families will be randomized to receive either a series of 4 mailed supports versus a single generic-content mailing. We will determine the respective impact of these two levels of post-visit support on stage of change, parental action on key obesity risk behaviors, child behaviors, and stabilization of BMI z scores after 6 months.